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Reporting an exposure

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please make sure you complete the correct form

For ongoing pregnancies
If you would like to let us know about an ongoing pregnancy in a woman who is taking medication or has been exposed to other substances in pregnancy please download and complete the reporting form for ongoing pregnancies.

For pregnancies that have ended
If you would like to let us know about a pregnancy that has ended (miscarriage, termination, stillbirth, intrauterine death, or live born) in a woman who took medication or was exposed to other substances in pregnancy please download and complete the reporting form for completed pregnancies.

Please note, NO advice will be provided by UKTIS when submitting these forms.

For case specific advice please contact UKTIS on 0344 892 0909. In order to provide the best possible information to inform an individual risk assessment for a pregnant woman and her baby following exposure to drugs or chemicals, UKTIS will require the following information:

 

 

 

 

 

 

 

 

 

Caller details

 

 

 

 

bullet pointName and contact details of the enquirer

 

 

 

 

bullet pointReferring unit and department

 

 

 

 

bullet pointDetails of midwife / GP / other relevant healthcare professional (for potential follow-up of fetal outcome)

 

 

 

 

 

 

 

 

 

Maternal details

 

 

 

 

bullet pointName, date of birth and NHS number (at least three identifiers)

 

 

 

 

bullet pointLMP and EDD

 

 

 

 

bullet pointMaternal medical and family history

 

 

 

 

 

 

 

 

 

Exposure details – therapeutic, overdose and chemical exposures

 

 

 

 

bullet pointStage of pregnancy at time of exposure

 

 

 

 

bullet pointAgent(s) involved (including route of exposure and estimated dose)

 

 

 

 

bullet pointDate and time of exposure

 

 

 

 

 

 

 

 

 

In addition, for therapeutic enquiries

 

 

 

 

bullet pointIndication for treatment

 

 

 

 

bullet pointProposed treatment (drug, dose, route, duration of treatment if known)

 

 

 

 

bullet pointAny treatments already tried

 

 

 

 

 

 

 

 

 

UKTIS data collection and processing is covered by Section 251 (NHS Act, 2006) which means that individual written patient consent is not required.  However, health professionals are asked, where possible, to ensure that the women involved are aware that their personal information is being reviewed and that they are happy for it to be used in this way.  For further information on Section 251 please click here.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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This page last updated 22/11/2016

 

 

 

 

 

 

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